Provider Demographics
NPI:1649223256
Name:APPLEGATE HOMECARE & HOSPICE, LLC
Entity Type:Organization
Organization Name:APPLEGATE HOMECARE & HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STONEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-621-6950
Mailing Address - Street 1:1492 E RIDGELINE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4105
Mailing Address - Country:US
Mailing Address - Phone:801-621-4027
Mailing Address - Fax:
Practice Address - Street 1:1492 E RIDGELINE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4105
Practice Address - Country:US
Practice Address - Phone:801-394-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAYWEST INVESTMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870644488001Medicaid
UTIDX9966OtherHEALTHY U
UT860644498001Medicaid
360859900OtherFEDERAL WORKER'S COMPENSA
=========OtherBLUE CROSS BLUE SHIELD
UT860644498001Medicaid
UT467025Medicare ID - Type UnspecifiedMEDICARE HOMECARE